Dynamics of the MRSA Population in a Chilean Hospital: a Phylogenomic Analysis (2000-2016)

The global dissemination of methicillin-resistant Staphylococcus aureus (MRSA) is associated with the emergence and establishment of clones in specific geographic areas. The Chilean-Cordobes clone (ChC) (ST5-SCCmecI) has been the predominant MRSA clone in Chile since its first description in 1998, despite the report of other emerging MRSA clones in recent years. Here, we characterize the evolutionary history of MRSA from 2000 to 2016 in a Chilean tertiary health care center using phylogenomic analyses. We sequenced 469 MRSA isolates collected between 2000 and 2016. We evaluated the temporal trends of the circulating clones and performed a phylogenomic reconstruction to characterize the clonal dynamics. We found a significant increase in the diversity and richness of sequence types (STs; Spearman r = 0.8748, P < 0.0001) with a Shannon diversity index increasing from 0.221 in the year 2000 to 1.33 in 2016, and an effective diversity (Hill number; q = 2) increasing from 1.12 to 2.71. The temporal trend analysis revealed that in the period 2000 to 2003 most of the isolates (94.2%; n = 98) belonged to the ChC clone. However, since then, the frequency of the ChC clone has decreased over time, accounting for 52% of the collection in the 2013 to 2016 period. This decline was accompanied by the rise of two emerging MRSA lineages, ST105-SCCmecII and ST72-SCCmecVI. In conclusion, the ChC clone remains the most frequent MRSA lineage, but this lineage is gradually being replaced by several emerging clones, the most important of which is clone ST105-SCCmecII. To the best of our knowledge, this is the largest study of MRSA clonal dynamics performed in South America. IMPORTANCE Methicillin-resistant Staphylococcus aureus (MRSA) is a major public health pathogen that disseminates through the emergence of successful dominant clones in specific geographic regions. Knowledge of the dissemination and molecular epidemiology of MRSA in Latin America is scarce and is largely based on small studies or more limited typing techniques that lack the resolution to represent an accurate description of the genomic landscape. We used whole-genome sequencing to study 469 MRSA isolates collected between 2000 and 2016 in Chile providing the largest and most detailed study of clonal dynamics of MRSA in South America to date. We found a significant increase in the diversity of MRSA clones circulating over the 17-year study period. Additionally, we describe the emergence of two novel clones (ST105-SCCmecII and ST72-SCCmecVI), which have been gradually increasing in frequency over time. Our results drastically improve our understanding of the dissemination and update our knowledge about MRSA in Latin America.

Ce/Pumice and Ni/Pumice as heterogeneous catalysts for syngas production from biomass gasification

This work presents a study of synthesis and characterization of catalysts-based cerium and nickel supported on the pumice stone (Ce/Pumice and Ni/Pumice) to be used in the gasification process of an invasive species present in the Canary Islands, such as Pennisetum setaceum to obtain syngas. Specifically, the effect of the metal impregnated on the pumice, and the effect of catalyst on the gasification process was studied. For this purpose, the composition of the gas was determined and the results obtained were compared with those obtained in non-catalytic thermochemical processes. Gasification tests were performed using a simultaneous thermal analyzer coupled with a mass spectrometer, providing a detailed analysis of the gases released during the process. The results showed that during the catalytic gasification process of the Pennisetum setaceum, the gases produced appear at lower temperatures in the catalytic process that in the non-catalytic process. Specifically, H₂ appears at 640.42 °C and 641.84 °C when Ce/pumice and Ni/pumice were used as catalyst, respectively, compared to 697.41 °C for the non-catalytic process. Moreover, the reactivity at 50 % of char conversion for the catalytic process (0.34 and 0.38 min^-1 for Ce/pumice and Ni/pumice, respectively) was higher than for the non-catalytic process (0.28 min^-1), indicating that the incorporation of Ce and Ni on the pumitic material increases the gasification rate of the char compared to the pumitic support. Catalytic biomass gasification is an innovative technology that can provide new opportunities for research and development of renewable energy technologies, as well as for the creation of green jobs.

A comprehensive review of the influence of co-solvents on the catalysed methanolysis process to obtain biodiesel

Non-polar oil and polar short-chain alcohols, used as reactants in the transesterification reaction, are immiscible. Transesterification reactions can only occur on the phase boundary and they are therefore diffusion-limited. Several methods are employed to overcome the limitation of mass transfer by increasing miscibility and thereby accelerating the reaction. Co-solvents are additional solvents that should be soluble in the oil and alcohol phase; this could lead to an increase in the reaction rate and a reduction in the temperature and the reaction time. This work aims to provide a comprehensive literature review on the influence of co-solvents on the processes of catalysed methanolysis for the biodiesel production. Most authors have not systematically determined and justified the effects of cosolvents. So far it seems impossible to establish which cosolvents are the most suitable for which methanolysis systems. The purpose of this work is to highlight and justify the differences or similarities in co-solvent impacts among the various publications by examining the chemical structure of the respective co-solvents, including the functional groups and the resulting physicochemical properties such as the dielectric constant or the log P value. Besides biodiesel, co-solvents like THF and acetone seems to be the best choices for alkaline methanolysis systems due to successful broadly applications with different oils, catalysts and reaction conditions. Moreover, THF and n-hexane are essentially advisable for in-situ methanolysis.

Molecular mechanisms leading to ceftolozane/tazobactam resistance in clinical isolates of Pseudomonas aeruginosa from five Latin American countries

Objectives

Identify molecular mechanisms responsible for the in vitro non-susceptibility to ceftolozane/tazobactam (TOL) in a group of 158 clinical isolates of Pseudomonas aeruginosa from five Latin American countries collected before the introduction of TOL into the clinical practice.

Methods

Clinical isolates of P. aeruginosa (n = 504) were collected between January 2016 and October 2017 from 20 hospitals located in Argentina, Brazil, Chile, Colombia, and Mexico. Minimum inhibitory concentrations (MICs) to TOL were determined by standard broth microdilution and interpreted according to CLSI breakpoints. Initially, production of carbapenemases in TOL non-susceptible isolates was assessed by Rapidec® followed by qPCR to detect bla_KPC, bla_NDM-1, bla_VIM, and bla_IMP. Illumina® WGS was performed for isolates in which non-susceptibility to TOL was not mediated by carbapenemases.

Results

A total of 158 (31.3%) isolates were non-susceptible to TOL. In 74 (46.8%) of these isolates, non-susceptibility to TOL was explained by the production of at least one carbapenemase. WGS revealed that some isolates carried ESBLs, mutated bla_PDC and ampD, associated with decreased susceptibility to TOL.

Conclusion

Substitutions found in PDC and carbapenemase production were the most common presumed mechanisms of resistance to TOL detected in this study. This study shows that epidemiological surveillance is warranted to monitor the emergence of novel mechanisms of resistance to TOL that might compromise its clinical utility.

Intracerebral and subarachnoid hemorrhage after suicidal "near-hanging"

Hanging is one of the most common methods of attempting suicide with a fast occurring death and a high lethality rate. Depending on how fast the hanged individuals are found, they may be rescued, which is referred to as "near-hanging." Whilst hypoxic and ischemic brain damage are common findings in hanging, intracranial hemorrhages seem to be a rare occurrence. To the authors' knowledge, this is the first autopsy case report of an intracerebral and subarachnoid hemorrhage in a delayed death after incomplete hanging. We hypothesize that the combination of two mechanisms is involved in the development of such hemorrhages. First, the persistent venous hypertension during incomplete hanging causing endothelial damage resulting in vascular leakage. Second, the reperfusion of the brain due to recovery of venous blood return after the release form the rope. Whereas intracranial hemorrhage is not a common finding in daily autopsy cases of fatal hanging, it might be a severe complication in rescued cases.

M/TiO2 (M = Fe, Co, Ni, Cu, Zn) catalysts for photocatalytic hydrogen production under UV and visible light irradiation

Cu/TiO₂ photocatalysts can be considered a promising low-cost alternative to the well-known Pt/TiO₂ system for hydrogen production under UV-Vis irradiation.

Prolactin decreases LPS-induced inflammatory cytokines by inhibiting TLR-4/NFκB signaling in the human placenta

Prolactin (PRL) plays an important role in trophoblast growth, placental angiogenesis and immunomodulation within the feto-maternal interface, where different cell types secrete PRL and express its receptor. During pregnancy, inflammatory signalling is a deleterious event that has been associated with poor fetal outcomes. The placenta is highly responsive to the inflammatory stimulus; however, the actions of PRL in placental immunity and inflammation remain largely unknown. The aim of this study was to evaluate PRL effects on the TLR4/NFkB signalling cascade and associated inflammatory targets in cultured explants from healthy term human placentas. An in utero inflammatory scenario was mimicked using lipopolysaccharides (LPS) from Escherichia coli. PRL significantly reduced LPS-dependent TNF-α, IL-1β and IL-6 secretion and intracellular levels. Mechanistically, PRL prevented LPS-mediated upregulation of TLR-4 expression and NFκB phosphorylation. In conclusion, PRL limited inflammatory responses to LPS in the human placenta, suggesting that this hormone could be critical in inhibiting exacerbated immune responses to infections that could threaten pregnancy outcome. This is the first evidence of a mechanism for anti-inflammatory activity of PRL in the human placenta, acting as a negative regulator of TLR-4/NFkB signaling.

Bogotá River anthropogenic contamination alters microbial communities and promotes spread of antibiotic resistance genes

The increase in antibiotic resistant bacteria has raised global concern regarding the future effectiveness of antibiotics. Human activities that influence microbial communities and environmental resistomes can generate additional risks to human health. In this work, we characterized aquatic microbial communities and their resistomes in samples collected at three sites along the Bogotá River and from wastewaters at three city hospitals, and investigated community profiles and antibiotic resistance genes (ARGs) as a function of anthropogenic contamination. The presence of antibiotics and other commonly used drugs increased in locations highly impacted by human activities, while the diverse microbial communities varied among sites and sampling times, separating upstream river samples from more contaminated hospital and river samples. Clinically relevant antibiotic resistant pathogens and ARGs were more abundant in contaminated water samples. Tracking of resistant determinants to upstream river waters and city sources suggested that human activities foster the spread of ARGs, some of which were co-localized with mobile genetic elements in assembled metagenomic contigs. Human contamination of this water ecosystem changed both community structure and environmental resistomes that can pose a risk to human health.

Ex Vivo and In Vivo Biocompatibility Assessment (Blood and Tissue) of Three-Dimensional Bacterial Nanocellulose Biomaterials for Soft Tissue Implants

Bacterial nanocellulose (BNC) is a promising biomedical material. However, the haemocompatibility (haemolysis and thrombogenicity) and acute and sub-chronic immune responses to three-dimensional (3D) BNC biomaterials have not been evaluated. Accordingly, this manuscript focused on the effect of 3D microporosity on BNC haemocompatibility and a comparison with 2D BNC architecture, followed by the evaluation of the immune response to 3D BNC. Blood ex vivo studies indicated that compared with other 2D and 3D BNC architectures, never-dried 2D BNC presented antihemolytic and antithrombogenic effects. Nevertheless, in vivo studies indicated that 3D BNC did not interfere with wound haemostasis and elicited a mild acute inflammatory response, not a foreign body or chronic inflammatory response. Moreover, compared with the polyethylene controls, the implant design with micropores ca. 60 µm in diameter showed a high level of collagen, neovascularization and low fibrosis. Cell/tissue infiltration increased to 91% after 12 weeks and was characterized by fibroblastic, capillary and extracellular matrix infiltration. Accordingly, 3D BNC biomaterials can be considered a potential implantable biomaterial for soft tissue augmentation or replacement.

From guidelines to real world: results from the National Multiple Myeloma Registry in Uruguay on 222 newly diagnosed multiple myeloma patients from 2012 to 2015

Introduction: In the last decade, substantial improvements in the understanding of the biology of multiple myeloma and the development of novel therapeutic options have led to increased response rates, progression free survival and overall survival. In underdeveloped countries, it is a huge challenge to adapt for this evolution, both in diagnostic and therapeutic aspects. Methods: We conducted a retrospective, national analysis of all patients with newly diagnosed multiple myeloma in a recent period. Diagnostic and prognostic evaluation is carried out according to international recommendations in the majority of patients. Results: The clinical presentation at diagnosis is similar to those reported internationally, although with higher rates of anemia and severe renal failure. Most patients were diagnosed in advanced Durie-Salmon stage (80%), with high ISS score (48% ISS 3). Treatment, both in candidates and non-candidates for transplantation, is conditioned by a limited supply of possibilities, scarce availability of new drugs and absence of clinical trials. This determines lower results in response depth and survival. At 32 months, overall survival was 61.8%, with a statistical difference in favor of younger patients, standard-risk MM and those treated with novel drugs. No patient received antibacterial or antifungal prophylaxis while the majority received adequate antiviral prophylaxis. Infections were the main cause of death (29.7%), overcoming the disease itself. Conclusions: This analysis allows us to raise awareness about strengths and weaknesses in our management of MM patients. There is a need to promote earlier detection, improve supportive care and reduce infection mortality. Greater availability of evidence-based recommended treatment options is required. Access to clinical trials is warranted if care is to be improved.

Genomic and Epidemiological Evidence of a Dominant Panton-Valentine Leucocidin-Positive Methicillin Resistant Staphylococcus aureus Lineage in Sri Lanka and Presence Among Isolates From the United Kingdom and Australia

Objective: To undertake the first detailed genomic analysis of methicillin-resistant Staphylococcus aureus (MRSA) isolated in Sri Lanka. Methods: A prospective observational study was performed on 94 MRSA isolates collected over a 4 months period from the Anuradhapura Teaching Hospital, Sri Lanka. Screening for mecA, mecC, and the Panton-Valentine leucocidin (PVL)-associated lukS-PV/lukF-PV genes and molecular characterization by spa typing was undertaken. Whole genome sequencing (WGS) and phylogenetic analysis was performed on selected multilocus sequence type (MLST) clonal complex 5 (CC5) isolates from Sri Lanka, England, Australia, and Argentina. Results: All 94 MRSA harbored the mecA gene. Nineteen spa types belonging to nine MLST clonal complexes were identified. Where origin of the sample was recorded, most isolates were from skin and soft tissue infections (70/91; 76.9%), with fewer causing bacteremia (16/91; 17.6%), empyema (3/91; 3.3%) and osteomyelitis (2/91; 2.2%). Sixty two (65.9%) isolates were PVL positive with the majority (56 isolates; 90.3%) belonging to a dominant CC5 lineage. This lineage, PVL-positive ST5-MRSA-IVc, was associated with both community and hospital-onset infections. Based on WGS, representative PVL-positive ST5-MRSA-IVc isolates from Sri Lanka, England and Australia formed a single phylogenetic clade, suggesting wide geographical circulation. Conclusions: We present the most detailed genomic analysis of MRSA isolated in Sri Lanka to date. The analysis identified a PVL-positive ST5-MRSA-IVc that is prevalent among MRSA causing clinical infections in Sri Lanka. Furthermore, this clone was also found among isolates from the United Kingdom and Australia.

Assessment of the use of ethanol instead of MTBE as an oxygenated compound in Mexican regular gasoline: combustion behavior and emissions

The energy reforms implemented in Mexico promote the use of ethanol in gasoline but exclude the country's ozone nonattainment areas oxygenated with methyl-tert-butyl ether (MTBE) in view that further scientific studies are required. To address a potential implementation scenario in areas of ozone high VOC-sensitive regimes, the impact on performance and emissions characteristics between the regular MTBE fuel available and a formulated gasoline containing 10% v/v ethanol having similar Reid vapor pressure (RVP) were compared in a single cylinder spark-ignited engine and a set of tier I vehicles. Included in the assessment were the "criteria" pollutants (THC, CO, and NO_x), toxic compounds, and speciated hydrocarbons in order to calculate the ozone-forming potential (OFP). The change in combustion speed of ethanol fuel vs. regular gasoline seems to be small and depends mainly on base gasoline formulation. Vehicle dynamometer testing showed no statistically significant differences in the average THC, CO, and NO_x results when comparing both fuels. Statistically significant differences were seen in total speciated hydrocarbons, total carbonyls emitted, the increases in acetaldehyde emissions, and the decreases in OFP with E10. The results show roughly 20% increase in evaporative emissions when E10 is used, but the OFP of the emissions is lower than that of the Metropolitan Area of Mexico City fuel (MAMC). The increase in the oxygen content using ethanol fuel seems to have no deleterious effect on the vintage of vehicles tested. Taking into consideration that the evaporative emissions standard in Mexico is less stringent than that in other countries, the substitution of the actual regular gasoline for ethanol fuels should uphold the least volatile AA class in areas with ozone problems.

Correction to: Pharmacometabolomics applied to zonisamide pharmacokinetic parameter prediction

The original version of this article contains a mistake.

Pharmacometabolomics applied to zonisamide pharmacokinetic parameter prediction

INTRODUCTION

Zonisamide is a new-generation anticonvulsant antiepileptic drug metabolized primarily in the liver, with subsequent elimination via the renal route.

OBJECTIVES

Our objective was to evaluate the utility of pharmacometabolomics in the detection of zonisamide metabolites that could be related to its disposition and therefore, to its efficacy and toxicity.

METHODS

This study was nested to a bioequivalence clinical trial with 28 healthy volunteers. Each participant received a single dose of zonisamide on two separate occasions (period 1 and period 2), with a washout period between them. Blood samples of zonisamide were obtained from all patients at baseline for each period, before volunteers were administered any medication, for metabolomics analysis.

RESULTS

After a Lasso regression was applied, age, height, branched-chain amino acids, steroids, triacylglycerols, diacyl glycerophosphoethanolamine, glycerophospholipids susceptible to methylation, phosphatidylcholines with 20:4 FA (arachidonic acid) and cholesterol ester and lysophosphatidylcholine were obtained in both periods.

CONCLUSION

To our knowledge, this is the only research study to date that has attempted to link basal metabolomic status with pharmacokinetic parameters of zonisamide.

Predictors of Poor Prognosis in Recurrent Hepatitis C After Liver Transplantation

BACKGROUND

Hepatitis C is a common indication for liver transplantation (LT). Hepatitis C virus (HCV) recurrence is universal in viremic patients. This recurrence is frequently very aggressive, with graft loss in less than 5 years. Our aim is to detect which factors are related to worse fibrosis at 1 year post-LT.

PATIENTS AND METHODS

Records of all HCV-positive transplanted patients in Hospital Universitario Nuestra Señora de la Candelaria from 1996 to 2014 were collected. The variables analyzed were donor and recipient age and gender, hypertension, diabetes, viral genotype, viral load at LT, hepatocellular carcinoma in the explant, anticoagulation or antiplatelet treatment, year of transplantation, and mean levels of tacrolimus in the first month. Severe recurrence was defined as fibrosis F3 by biopsy, liver stiffness > 9.5 kPa by transient elastography, or hepatic venous pressure gradient > 5 mm Hg at 1 year post-LT. Univariate and multivariate analyses were performed.

RESULTS

From a sample of 112 patients, 88 patients met inclusion criteria. Mean recipient age was 52.8 ± 8.0 years and 70.5% were men. Mean donor age was 46.4 ± 16.1 years and 59.1% were men. Severe recurrence occurred in 23.9%. Univariate analyses showed 3 variables were statistically significant: donor age (P = .03), recipient age (P = .008), and presence of hepatocellular carcinoma (P = .01). Only the 2 first variables remained significant in the multivariate model (P = .009 and P = .044 respectively). Hepatocellular carcinoma was probably related to older recipients becoming a confounding factor.

CONCLUSIONS

In our study, donor and recipient age both conferred a worse prognosis in terms of fibrosis progression in patients with liver transplant due to HCV.

18F-FDG PET/CT in the clinical management of patients with lymphoma

The aim of this work was to review the current recommendations for staging and response assessment of patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) in routine clinical practice after chemotherapy and/or stem cell transplantation. A five-point scale (5-PS) from the First International Workshop on PET in Lymphoma in Deauville, France, in 2009, was recommended as the standard tool to score imaging to assess treatment response in patients with lymphoma using ¹⁸F-Fluorodeoxyglucose (FDG) PET/CT. Following the recommendations of the 11th and 12th International Conferences on Malignant Lymphoma held in Lugano (Switzerland), in 2011 and 2013, respectively, a consensus (the so-called Lugano Classification) was reached regarding the use of PET/CT for staging and response assessment in FDG-avid lymphomas. As a result, ¹⁸F-FDG PET/CT was formally incorporated into standard staging for FDG-avid lymphomas. A bone marrow biopsy is no longer indicated for the routine staging of HL and most diffuse large B-cell lymphomas. PET/CT will be used to assess response in FDG-avid histologies using the 5-point scale. The recent introduction of biological agents with immune mechanisms requires flexibility in interpretations of the Lugano criteria due to tumour flare or a pseudo-progression effect produced by these agents. Provisional criteria have been proposed (Lymphoma Response to Immunomodulatory Therapy Criteria) with the introduction of the term 'Indeterminate Response' in order to identify this phenomenon until confirmed as flare/pseudoprogression or true progression. All these recommendations will improve evaluations of patients with lymphoma, and allow comparison of results from clinical practice and trials.

Relationship between CCR5(WT/Δ32) heterozygosity and HIV-1 reservoir size in adolescents and young adults with perinatally acquired HIV-1 infection

BACKGROUND

Several host factors contribute to human immunodeficiency virus (HIV) disease progression in the absence of combination antiretroviral therapy (cART). Among them, the CC-chemokine receptor 5 (CCR5) is known to be the main co-receptor used by HIV-1 to enter target cells during the early stages of an HIV-1 infection.

OBJECTIVE

We evaluated the association of CCR5^(WT/Δ32) heterozygosity with HIV-1 reservoir size, lymphocyte differentiation, activation and immunosenescence in adolescents and young adults with perinatally acquired HIV infection receiving cART.

METHODS

CCR5 genotype was analysed in 242 patients with vertically transmitted HIV-1 infection from Paediatric Spanish AIDS Research Network Cohort (coRISpe). Proviral HIV-1 DNA was quantified by digital-droplet PCR, and T-cell phenotype was evaluated by flow cytometry in a subset of 24 patients (ten with CCR5^(Δ32/WT) genotype and 14 with CCR5^(WT/WT) genotype).

RESULTS

Twenty-three patients were heterozygous for the Δ32 genotype but none was homozygous for the mutated CCR5 allele. We observed no difference in the HIV-1 reservoir size (455 and 578 copies of HIV-1 DNA per million CD4⁺ T cells in individuals with CCR5^(WT/WT) and CCR5^(Δ32/WT) genotypes, respectively; p 0.75) or in the immune activation markers between both genotype groups. However, we found that total HIV-1 DNA in CD4⁺ T cells correlated with the percentage of memory CD4⁺ T cells: a direct correlation in CCR5^(WT/Δ32) patients but an inverse correlation in those with the CCR5^(WT/WT) genotype.

CONCLUSIONS

This finding suggests a differential distribution of the viral reservoir compartment in CCR5^(WT/Δ32) patients with perinatal HIV infection, which is a characteristic that may affect the design of strategies for reservoir elimination.

[Randomised clinical trial to evaluate the efficacy and safety of a new pediculicide made with saponified olive oil in the eradication of Pediculus humanus capitis]

INTRODUCTION

The aim of the study was to evaluate the efficacy and safety of a new pediculicide in the eradication of Pediculus humanus capitis infestation.

MATERIAL AND METHODS

A randomised clinical trial was designed, in which children aged between 5 and 15 years diagnosed with pediculosis were selected. Treatment was administered on days 1 and 7 after selection, and they were evaluated in 4 visits (day 2, 7, 9, and 14). The product under evaluation with saponified olive oil was Inex Pediculicide Soap^®, which was compared with Paranix^®, with a similar mechanism of action. The primary efficacy endpoint was the eradication of the parasite by day 14 (louse-free rate), using an intention to treat analysis.

RESULTS

Six paediatricians from 5 Primary Health Care centres in the Community of Madrid (Spain) and one private clinic participated in the study. A total of 45 children were included, of which 75.6% were girls (n=34). The mean age was 7.1 years (95% CI 6.3-7.9). The large majority (80%) were middle class, and 82.2% had a history of previous pediculosis. The efficacy at 14 days was 76.2% (95% CI 52.8-91.8) in the group treated with Inex Pediculicide Soap^® group, and 79.2% (95% CI 57.9-92.9) in Paranix^® group (NNT=33.3). No adverse effects were observed with treatment.

CONCLUSIONS

The 2 products were effective and safe in the eradication therapy Pediculus humanus capitis, with no statistical differences.

A cis-acting element in the promoter of human ether à go-go 1 potassium channel gene mediates repression by calcitriol in human cervical cancer cells

The human ether à go-go 1 potassium channel (hEAG1) is required for cell cycle progression and proliferation of cancer cells. Inhibitors of hEAG1 activity and expression represent potential therapeutic drugs in cancer. Previously, we have shown that hEAG1 expression is downregulated by calcitriol in a variety of cancer cells. Herein, we provided evidence on the regulatory mechanism involved in such repressive effect in cells derived from human cervical cancer. Our results indicate that repression by calcitriol occurs at the transcriptional level and involves a functional negative vitamin D response element (nVDRE) E-box type in the hEAG1 promoter. The described mechanism in this work implies that a protein complex formed by the vitamin D receptor-interacting repressor, the vitamin D receptor, the retinoid X receptor, and the Williams syndrome transcription factor interact with the nVDRE in the hEAG1 promoter in the absence of ligand. Interestingly, all of these transcription factors except the vitamin D receptor-interacting repressor are displaced from hEAG1 promoter in the presence of calcitriol. Our results provide novel mechanistic insights into calcitriol mode of action in repressing hEAG1 gene expression.

The contribution of evaporative emissions from gasoline vehicles to the volatile organic compound inventory in Mexico City

The strategy for decreasing volatile organic compound emissions in Mexico has been focused much more on tailpipe emissions than on evaporative emissions, so there is very little information on the contribution of evaporative emissions to the total volatile organic compound inventory. We examined the magnitudes of exhaust and evaporative volatile organic compound emissions, and the species emitted, in a representative fleet of light-duty gasoline vehicles in the Metropolitan Area of Mexico City. The US "FTP-75" test protocol was used to estimate volatile organic compound emissions associated with diurnal evaporative losses, and when the engine is started and a journey begins. The amount and nature of the volatile organic compounds emitted under these conditions have not previously been accounted in the official inventory of the area. Evaporative emissions from light-duty vehicles in the Metropolitan Area of Mexico City were estimated to be 39 % of the total annual amount of hydrocarbons emitted. Vehicles built before 1992 (16 % of the fleet) were found to be responsible for 43 % of the total hydrocarbon emissions from exhausts and 31 % of the evaporative emissions of organic compounds. The relatively high amounts of volatile organic compounds emitted from older vehicles found in this study show that strong emission controls need to be implemented in order to decrease the contribution of evaporative emissions of this fraction of the fleet.

Expression of gut-homing β7 receptor on T cells: surrogate marker for microbial translocation in suppressed HIV-1-infected patients?

OBJECTIVES

In view of the fact that mucosal damage associated with HIV-1 infection leads to microbial translocation despite successful antiretroviral treatment, we analysed microbial translocation and expression of the gut-homing β7 receptor on peripheral T cells in HIV-1-infected individuals.

METHODS

Fifteen long-term suppressed HIV-1-infected patients, of whom seven had their treatment intensified with maraviroc and eight with raltegravir, were included in the study. Samples at baseline, at week 48 of intensification, and at weeks 12 and 24 after deintensification were analysed for soluble CD14, lipopolysaccharide (LPS), LPS-binding protein, gut-homing β7 receptor and T-cell subsets.

RESULTS

The increases in both microbial translocation and expression of the gut-homing β7 receptor on activated CD8 T cells found during maraviroc intensification were reduced after deintensification. Moreover, the correlations between activated β7(+) T cells and LPS levels found during intensification with maraviroc (P = 0.036 and P = 0.010, respectively) were lost during deintensification. In contrast, microbial translocation was stable during raltegravir intensification, with the exception of decreased LPS levels and activated CD4 β7(+) T cells, which reverted to baseline values after deintensification.

CONCLUSIONS

Microbial translocation is an important factor in gut immune activation and mucosa inflammation, as evidenced by the association between the dynamics of microbial translocation and activated T cells expressing the gut-homing β7 receptor. The recruitment of activated β7(+) T cells to the gut tract when alteration of microbial translocation is maximum may be the major mechanism for recovery of mucosal integrity.

[Resistance to "last resort" antibiotics in Gram-positive cocci: The post-vancomycin era]

New therapeutic alternatives have been developed in the last years for the treatment of multidrug-resistant Gram-positive infections. Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) are considered a therapeutic challenge due to failures and lack of reliable antimicrobial options. Despite concerns related to the use of vancomycin in the treatment of severe MRSA infections in specific clinical scenarios, there is a paucity of solid clinical evidence that support the use of alternative agents (when compared to vancomycin). Linezolid, daptomycin and tigecycline are antibiotics approved in the last decade and newer cephalosporins (such as ceftaroline and ceftobiprole) and novel glycopeptides (dalvavancin, telavancin and oritavancin) have reached clinical approval or are in the late stages of clinical development. This review focuses on discussing these newer antibiotics used in the "post-vancomycin" era with emphasis on relevant chemical characteristics, spectrum of antimicrobial activity, mechanisms of action and resistance, as well as their clinical utility.

Subjects with impaired fasting glucose: evolution in a period of 6 years

AIM

To study the evolution of impaired fasting glucose (IFG), considering glucose and HbA1c levels and risk factors associated, in a period of 6 years.

METHODS

We studied 94 subjects with impaired fasting glucose (IFG) that were diagnosed in 2005 and followed up to 2012. Glucose and HbA1c levels were determined. A descriptive analysis of contingence charts was performed in order to study the evolution in the development of type-2 diabetes mellitus (T2DM).

RESULTS

Twenty-eight of ninety-four subjects became T2DM; 51/94 remained with IFG; and 20/94 presented normal fasting glucose. From the 28 diabetic subjects, 9 had already developed diabetes and were under treatment with oral hypoglycemic agents; 5 were diagnosed with plasma glucose < 126 mg/dL, but with HbA1c over 6.5%. In those who developed diabetes, 15/28 had a family history of T2DM in first relative degree. Also, diabetic subjects had a BMI significantly higher than nodiabetics (t test: P < 0.01). The individuals that in 2005 had the highest BMI are those who currently have diabetes.

CONCLUSION

The IFG constitutes a condition of high risk of developing T2DM in a few years, especially over 110 mg/dL and in obesity patients.

KCNH1 potassium channels are expressed in cervical cytologies from pregnant patients and are regulated by progesterone

Potassium voltage-gated channel, subfamily H (eag-related), member 1 (KCNH1) potassium channels are potential tumour markers and cancer therapeutic targets and are up-regulated by oestrogens and human papilloma virus (HPV) oncogenes. However, the role of KCNH1 in normal tissues is poorly understood, and its expression in pregnancy is unknown. We wondered whether KCNH1 channels are expressed in cervical cells from pregnant patients and whether progesterone (P4) regulates KCNH1. The association with HPV was also investigated. KCNH1 protein expression was studied by immunocytochemistry in liquid-based cervical cytologies; 93 samples were obtained from pregnant patients at different trimesters, and 15 samples were obtained from non-pregnant women (controls). The presence ofHPVwas studied by PCR with direct sequencing and nested multiplex PCR. HeLa cervical cancer cells were transfected with human progesterone receptor-B (PR-B) and treated with P4.KCNH1mRNA expression in these cultures was studied by real-time PCR. KCNH1 protein was detected in 100% of the pregnancy samples and in 26% of the controls. We found 18 pregnant patients infected with HPV and detected 14 types ofHPV. There was no association between the percentage of cells expressing KCNH1 and either the presence or type of HPV. P4induced KCNH1 mRNA and protein expression in cells transfected with human PR-B. No regulation of KCNH1 by P4was observed in non-transfected cells. We show for the first time the expression of an ion channel during human pregnancy at different trimesters and KCNH1 regulation by P4in human cells. These data raise a new research field for KCNH1 channels in human tissues.

Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results

OBJECTIVE

To assess the feasibility of a specific training program for ultrasound diagnosis of adnexal masses.

METHODS

A 2-month intensive training program was developed. The program protocol consisted of a 1-day intensive theoretical course focused on clinical and sonographic issues related to adnexal masses and ovarian cancer, followed by a 4-week real-time ultrasound training program in a tertiary center (25-30 adnexal masses evaluated per month) and a final 4-week period for offline assessment of three-dimensional (3D) volumes from adnexal masses. In this final period, each trainee evaluated five sets of 100 3D volumes. 3D volumes contained gray-scale and power Doppler information, and the trainee was provided with clinical data for each case (patient age, menopausal status and reported symptoms). 3D volumes were obtained from surgically removed masses that had undergone histological diagnosis or from masses that had been followed up until resolution. After assessment of each set, the trainee's diagnostic performance was calculated (sensitivity and specificity) and each incorrectly classified mass was evaluated with the trainer. The objective was to achieve a sensitivity of > 95% and a specificity of > 90%. Learning curve cumulative summation (LC-CUSUM) graphs were plotted to assess the learning curve for the trainees.

RESULTS

One trainer and two trainees with little experience in gynecological ultrasound (one gynecologist and one radiologist) participated in this study. LC-CUSUM graphs showed that competence was achieved after 170 or 185 examinations. The objectives for diagnostic performance were achieved after assessment of the second set of 3D volumes (200 cases) for each trainee.

CONCLUSIONS

The proposed training program appears to be feasible. High diagnostic performance can be achieved after analysis of 200 cases and maintained thereafter.

Impact of reformulated ethanol-gasoline blends on high-emitting vehicles

In-use vehicles which are high emitters (HEVs) make a large contribution to the emissions inventory. It is not known, however, whether HEVs share common emissions characteristics, and particularly the effect of ethanol blends. We study this by first examining laboratory measurements of exhaust and evaporative emissions on ethanol blends containing 21%, 26% and 30% aromatics, and a reference fuel formulated with methyl-tertiary butyl ether (MTBE). Switching from MTBE to ethanol fuels on HEVs shows no effect on the total emissions of regulated pollutants, but 1,3-butadiene emissions would increased substantially while the emissions of total carbonyls would not be affected except in the case of acetaldehyde, which would increase with EtOH. The ozone-forming potential of exhaust and evaporative emissions would be less using the EtOH blends and specific reactivity will not be incremented. Lowering the vapour pressure of the gasoline and increasing the proportions of alkylate and isomerate in the composition produces an ethanol-blended fuel with lower environmental impact both in normal vehicles and HEVs.

Low-quality vegetable oils as feedstock for biodiesel production using K-pumice as solid catalyst. Tolerance of water and free fatty acids contents

Waste oils are a promising alternative feedstock for biodiesel production due to the decrease of the industrial production costs. However, feedstock with high free fatty acids (FFA) content presents several drawbacks when alkaline-catalyzed transesterification reaction is employed in biodiesel production process. Nowadays, to develop suitable processes capable of treating oils with high free fatty acids content, a two-step process for biodiesel production is being investigated. The major problem that it presents is that two catalysts are needed to carry out the whole process: an acidic catalyst for free fatty acids esterification (first step) and a basic catalyst for pretreated product transesterification (second step). The use of a bifunctional catalyst, which allows both reactions to take place simultaneously, could minimize the production costs and time. In the present study, the behavior of pumice, a natural volcanic material used as a heterogeneous catalyst, was tested using oils with several FFA and water contents as feedstock in the transesterification reaction to produce biodiesel. Pumice as a bifunctional solid catalyst, which can catalyze simultaneously the esterification of FFA and the transesterification of fatty acid glycerides into biodiesel, was shown to be an efficient catalyst for the conversion of low-grade, nonedible oil feedstock into biodiesel product. Using this solid catalyst for the transesterification reaction, high FAME yields were achieved when feedstock oils presented a FFA content until approximately 2% wt/wt and a water content until 2% wt/wt.

Specific patterns of CD4-associated immunosenescence in vertically HIV-infected subjects

Vertical transmission of human immunodeficiency virus (HIV) represents an important world-wide health problem although the incidence in developed countries has been drastically reduced by the extensive use of highly active antiretroviral therapy. Vertically HIV-infected subjects have been exposed to the virus during the maturation of their immune systems and have suffered a persistent chronic activation throughout their lifetime; the consequences of this situation for their immune system are not fully understood. The objective of this study was to analyse immunosenescence-related parameters in different CD4 T-cell subsets. Fifty-seven vertically HIV-infected subjects and 32 age-matched healthy subjects were studied. Activation (HLA(-) DR(+) ), senescence (CD28(-) CD57(+) ) and proliferation (Ki67(+) ) were analysed on different CD4 T-cell subsets: naive (CD45RA(+) CD27(+) ), memory (CD45RO(+) CD27(+) ), effector memory (CD45RO(+) CD27(-) ) and effector memory RA (CD45RA(+) CD27(-) ). Compared with healthy subjects, vertically HIV-infected subjects showed increased naive and memory CD4 T-cell frequencies (p 0.035 and p 0.010, respectively) but similar frequencies of both effector subsets. Whereas naive CD4 T cells were not further altered, memory CD4 T cells presented increased levels of senescence and proliferation markers (p <0.001), effector memory CD4 T cells presented increased levels of activation, senescence and proliferation markers (p <0.001) and effector memory RA CD4 T cells presented increased levels of activation and senescence (p <0.001) compared with healthy subjects. Despite long periods of infection, vertically HIV-infected subjects show specific patterns of immunosenescence, revealing a preserved CD4 T-cell homeostasis for subset differentiation and distribution. Nevertheless, excepting the naive subpopulation, all subsets experienced some immunosenescence, pointing to uncertain consequences of the future aging process in these subjects.

Alkali Metal Exchanged Zeolite as Heterogeneous Catalyst for Biodiesel Production from Sunflower Oil and Waste Oil: Studies in a Batch/Continuous Slurry Reactor System

Biodiesel as an alternative fuel has become more important in recent times due to the increasing awareness of fossil fuel resources and the environmental benefits. The main disadvantages are its cost and availability of fats and oils resources. By collecting used frying oils and converting them to biodiesel fuel, the cost of biodiesel is significantly lowered and the negative impact of disposing used oil to environment reduced.The aim of this study was to analyse the performance of several alkali metal exchanged zeolites as heterogeneous catalysts for biodiesel production from sunflower oil and waste oil. Several catalysts studied showed a high activity for transesterification reaction with batch or continuous flow reactor operation conditions performed: temperature (100- 155°C), methanol/oil molar ratio (12:1- 72:1 mol/mol) and catalyst concentration (3-6 wt %). Results indicated that biodiesel production using waste oil as feedstock has good potential because it is an inexpensive and available feedstock.

Seasonality and edge effect determine herbivory risk according to different plant association models

We report evidence of hierarchical resource selection by large herbivores and plant neighbouring effects in a Mediterranean ecosystem. Plant palatability was assessed according to herbivore foraging decisions. We hypothesize that under natural conditions large herbivores follow a hierarchical foraging pattern, starting at the landscape scale, and then selecting patches and individual plants. A between- and within-patch selection study was carried out in an area formed by scrubland and pasture patches, connected by habitat edges. With regard to between-patch selection, quality-dependent resource selection is reported: herbivores mainly consume pasture in spring and woody plants in winter. Within-patch selection was also observed in scrub habitats, influenced by season, relative patch palatability and edge effect. We defined a Proximity Index (PI) between palatable and unpalatable plants, which allowed verification of neighbouring effects. In spring, when the preferred food resource (i.e. herbs) is abundant, we observed that in habitat edges large herbivores basically select the relatively scarce palatable shrubs, whereas inside scrubland, unpalatable shrub consumption was related to increasing PI. In winter, a very different picture was observed; there was low consumption of palatable species surrounded by unpalatable species in habitat edges, where the latter were more abundant. These outcomes could be explained though different plant associations described in the literature. We conclude that optimal foraging theory provides a conceptual framework behind the observed interactions between plants and large herbivores in Mediterranean ecosystems.

Cold-start and chemical characterization of emissions from mobile sources in Mexico

In this work tailpipe and evaporative emissions from a set of normal and high emitter vehicle models, year 2006-2008 (low mileage) certified when new to meet the Tier 1 emission standard, were characterized for criteria pollutants (carbon monoxide, nitrogen oxides and hydrocarbons), and a suite of unregulated emissions including aliphatic and aromatic aldehydes, monocyclic aromatic compounds, 1,3 butadiene, n-hexane and acrolein. Data were obtained under the three different driving conditions of the United States Federal Test Procedure, FTP-75 cycle. High emissions of both regulated and unregulated pollutants were observed in the cold-start phase of the driving cycle for low mileage Tier 1 normal and high emitters engines. Data were compared with results obtained for a set of MY > 1992-2005 that included vehicles with no catalytic converters, Tier 0 and MY 2000-5 Tier 1 emission standard with high mileage. The calculated average cold-start emissions for normal emitters in grams are 0.93, 8.21 and 1.06 for NMHC CO, and NOx, respectively for Tier 1 low mileage vehicles. The reductions in emissions for Tier 1 normal emitters are 76%, 56% and 56% for NMHC, CO and NOx, respectively, but 58%, 30% and 25% for the high emitters. Differences in emission can be ascribed to the mileage accumulation more than technological improvements. Cold-start emissions account in the USA roughly 10% of emissions from gasoline-powered vehicles. In Mexico the fractions are likely to be higher because one must account also for the contribution of Tier 0 and the running exhausts emissions of vehicles with no catalytic converters.